| NPI | 1730113192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP60758010) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA DO.000037) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-11-20 |